Year: 2024
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Treatment options for patients with advanced neuroendocrine tumors are limited. The efficacy of cabozantinib in the treatment of previously treated, progressive extrapancreatic or pancreatic neuroendocrine tumors is unclear. METHODS: We enrolled two independent cohorts of patients - those with extrapancreatic neuroendocrine tumors and those with pancreatic neuroendocrine tumors - who had received peptide receptor radionuclide therapy or targeted therapy or both. Patients were randomly assigned in a 2:1 ratio to receive cabozantinib at a dose of 60 mg daily or placebo. The primary end point was progression-free survival as assessed by blinded independent central review. Key secondary end points included objective response, overall survival, and safety. RESULTS: In the cohort of 203 patients with extrapancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 8.4 months, as compared with 3.9 months with placebo (stratified hazard ratio for progression or death, 0.38; 95% confidence interval [CI], 0.25 to 0.59; P<0.001). In the cohort of 95 patients with pancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 13.8 months, as compared with 4.4 months with placebo (stratified hazard ratio, 0.23; 95% CI, 0.12 to 0.42; P<0.001). The incidence of confirmed objective response with cabozantinib was 5% and 19% among patients with extrapancreatic and pancreatic neuroendocrine tumors, respectively, as compared with 0% with placebo. Grade 3 or higher adverse events were noted in 62 to 65% of the patients treated with cabozantinib, as compared with 23 to 27% of the patients who received placebo. Common treatment-related adverse events of grade 3 or higher included hypertension, fatigue, diarrhea, and thromboembolic events. CONCLUSIONS: Cabozantinib, as compared with placebo, significantly improved progression-free survival in patients with previously treated, progressive advanced extrapancreatic or pancreatic neuroendocrine tumors. Adverse events were consistent with the known safety profile of cabozantinib. (Funded by the National Cancer Institute and others; CABINET ClinicalTrials.gov number, NCT03375320.).
Source: New England Journal of Medicine
Authors: Jennifer A. Chan, Susan Geyer, Tyler Zemla, Michael V. Knopp, Spencer Behr, Sydney Pulsipher, Fang-Shu Ou, Amylou C. Dueck, Jared Acoba, Ardaman Shergill, Edward M. Wolin, Thorvardur R. Halfdanarson, Bhavana Konda, Nikolaos A. Trikalinos, Bernard Tawfik, Nitya Raj, Shagufta Shaheen, Namrata Vijayvergia, Arvind Dasari, Jonathan R. Strosberg, Elise C. Kohn, Matthew H. Kulke, Eileen M. O’Reilly, Jeffrey A. Meyerhardt
Institutions: Boston University, Boston Medical Center, Mayo Clinic, Dana-Farber Cancer Institute, The Ohio State University, University of Cincinnati, University of California, San Francisco, Mayo Clinic in Arizona, University of Hawaii Cancer Center, University of Chicago, Mayo Clinic Comprehensive Cancer Center (Minnesota), The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Washington University in St. Louis, Alvin J. Siteman Cancer Center, UNM Comprehensive Cancer Center, Memorial Sloan Kettering Cancer Center, Stanford Medicine, Stanford University, Fox Chase Cancer Center, The University of Texas MD Anderson Cancer Center, Moffitt Cancer Center, National Institutes of Health, National Cancer Institute
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1015086585, G1065259983, G1433257019, G1461372535, ECOG-ACRIN Network Group Operations Center, G1938688226, G2314833875, G2819266960, G3100437649, G3231584006, G33208427, Network Lead Academic Participating Site: Memorial Sloan Kettering Cancer Center, G4185274752, G4188603810, NRG Oncology Network Group Operations Center, G4542188341, G5009787934, G5432854847, NCTN Lead Academic Participating Site at Dana-Farber/Partners Cancer Care, G580335595, G6105514657, G6536185887, G6705915398, G815495650, G8225661566, Alliance for Clinical Trials in Oncology Operations Center, G8847213763, G9000097678, G9000137838, G9000234013, G9000280145, Cancer Center Support Grant, G93539815
OpenAlex ID: W4402581225